Thursday, October 27, 2011

More activity

I had hoped this week to move on to a more reflective blog post, but it has been busy, so I will just report.  The short version is that I was in Memorial Hospital for two days, now have a filter in my inferior vena cava, and am home mending, hoping that the challenges of the last few weeks are behind me.

The longer version (only for people who like medical details!)

I have been injecting a low molecular weight Heparin twice daily into my abdomen for about three weeks now, to deal with the blood clots from the Avastin.  I have also been struggling with a cold that ended into a deep chest cough.  The coughing caused more abdominal pain, but that came and went. Last weekend I was feeling pretty good; nice dinner party here Saturday night, and I went to Pocono on a beautiful fall day for a Board meeting on Sunday.  But Sunday night the belly pain got worse, and continued to do so Monday.  I called the oncologist's office and was told to go to the urgent care center (UCC) at MSKCC.  Many more tests, culminating in a CT scan, and admission to Memorial Hospital.  Seems I had somehow (coughing?) broken a blood vessel in my abdominal wall.  It had bled profusely due to the Heparin, so I had a large volume of blood there.  (My poor abused abdomen was quite distended and very painful to touch.  But it has never been a pretty sight.)

That night they gave me Morphine for pain and a blood transfusion since my Hemoglobin had fallen considerably.  The next morning I felt a little better.  They started me on oxygen (with the cough I had not been breathing well), as well as a nebulizer with Albuterol.  My temperature rose to 100.7 F.  That seemed to galvanize the attention of the team of docs, so IV antibiotics were started.  Interestingly, no one said "pneumonia" but it appeared that that was what they were treating.

In the meantime, they had decided on an entirely new strategy to deal with the clots.  A filter (actually a little metal device that looks like a fabric-less umbrella) can be inserted into the inferior vena cava (IVC) to catch clots that might otherwise do mischief.  Done by an interventional radiologist (they insert stents etc.) through an incision in the neck.  This was scheduled for that night.

I was taken to the interventional radiology (IR) department in the early evening.  The doctor (and don't call them a radiologist unless you want a scolding: "interventional" is very important) explained the procedure, and I signed a consent form.  Then the anesthesiologist came in and listened to my lungs and said no way.  Since my breathing was already impaired, and since I was known to be allergic to the required contrast agent, it was too risky.  A bit of an argument between them, but back upstairs I went.

Lots of more activity to improve the lungs the next day: nebulizer, oxygen, etc., and I was really breathing better.  Prednisone and benedryl again, to keep the allergic reaction at bay.  And no eating after midnight.  I am beginning to think of fasting as the MSKCC diet. The procedure was scheduled for 2:30, then 4:30, then...

Back to the IR waiting area around 5:30.  Another pissing contest.  The anesthesiologist came in first, asked a few questions, but had not started the physical exam.  The IR doc (both were different from the previous day) breezed in, interrupted her, described the procedure to me, got the consent form, etc.  The anesthesiologist suggest that he slow down, she needed to see if I was ok for it yet, that it had been properly stopped the night before.  The IR doc puffed up and said this was not elective: precisely since I had lung problems, preventing a pulmonary embolism made the procedure necessary.   She politely said that she needed to examine me.  I was not happy: I would prefer that the docs doing the procedure not be at war.  Fortunately she was convinced that my lungs sounded ok, so she was ok to proceed.  Was this a gender dynamic, or was it a dump-on-the-anesthesiologist power play, or both?  My GP has made snide remarks about anesthesiologists' penchant for excessive caution.  But I, the patient, want a cautious anesthesiologist!

Anyway the procedure went well.  It took about 30 minutes, and I was awake throughout.  The catheter moves right through the beating heart, but the image was not up on the jumbotron screens that I could see.  I think he placed the device above the renal vein, since there is still a tumor there, and tumors can throw clots.  The more standard placement it a bit lower.  And I didn't develop any hives.

Back in my hospital room at around 8 PM.  The nurse said it was my call on whether to go home then or the next morning.  I said I was ready to go.  She had to work hard to make it happen: find the pain meds that were supposed to be ready for me, get instructions that the IR people hadn't given me, etc.  But the nurses at MSKCC are unfailingly helpful and supportive, so we left at 11 PM.  The many postponements had made it possible for my faithful friend Helene to be there for the procedure and to escort me home.

Still a very painful belly, but it should heal on its own.  I am very glad to be off the injections!  And cancer doctors do not hesitate to hand out serious pain medications, so I have morphine pills. (Still off both Tylenol and NSAIDS.) The antibiotics should help with the lung and cough, I hope.  The Avastin scheduled for today postponed a week, but perhaps then the full double-barreled treatment can resume.

1 comment:

Sasha said...

I'm glad that everything sounds like it went smoothly considering the circumstances. the nurses at MSKCC are amazing; angels compared to some i've seen.
the "pissing" on anesthesiologists from IR docs (and surgeons) is apparently all too prevalent. I do my anesthesiology rotation in december, will be interesting to see it from the other side.

Wishing you a speedy recovery so you can safely resume your treatment.